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First Name

Middle Name

Last Name

Date Of Birth

Gender

Male Female

Race/Ethnicity

Hispanic or Latino White (Not Hispanic or Latino) Black or African-American (Not Hispanic or Latino) Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) Asian (Not Hispanic or Latino) American Indian or Alaska Native (Not Hispanic or Latino) Other:

Describe Others

Current Address

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

Phone Number

E-mail

1) Previous Address

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

2) Previous Address

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

3) Previous Address

Address Line 1

Address Line 2

Address Line 3

City

State

Zip

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Position Applying For

Location Applying For

Have you worked for this company before?

Yes No

Employment Desired?

Full-Time Part-Time Either

Desired Salary

Rate Per Hour

I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States

Yes No

Have you ever been bonded?

Yes No

How did you find out about this position?

Current Employee Search Engine Other

Describe Other

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

1) Employer Address

Fax

Address Line 1

Address Line 2

State

Zip

Contact Person and Phone Number

Position Held, Salary/Wage, Reason For Leaving

Start Date

End Date

Were you subject to the FMCSRs while employed?

Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alchohol testing requirements for 49 CFR Part 40?

Yes No

2) Employer Address

Fax

Address Line 1

Address Line 2

State

Zip

Contact Person and Phone Number

Position Held, Salary/Wage, Reason For Leaving

Start Date

End Date

Were you subject to the FMCSRs while employed?

Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alchohol testing requirements for 49 CFR Part 40?

Yes No

3) Employer Address

Fax

Address Line 1

Address Line 2

State

Zip

Contact Person and Phone Number

Position Held, Salary/Wage, Reason For Leaving

Start Date

End Date

Were you subject to the FMCSRs while employed?

Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alchohol testing requirements for 49 CFR Part 40?

Yes No

4) Employer Address

Fax

Address Line 1

Address Line 2

State

Zip

Contact Person and Phone Number

Position Held, Salary/Wage, Reason For Leaving

Start Date

End Date

Were you subject to the FMCSRs while employed?

Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alchohol testing requirements for 49 CFR Part 40?

Yes No

5) Employer Address

Fax

Address Line 1

Address Line 2

State

Zip

Contact Person and Phone Number

Position Held, Salary/Wage, Reason For Leaving

Start Date

End Date

Were you subject to the FMCSRs while employed?

Yes No

Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alchohol testing requirements for 49 CFR Part 40?

Yes No

* Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

**The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 8 or more passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE

Last Accident

Nature Of Accident

Fatalities/Injuries

Hazardous Material Spill

We are small company located in Clearwater Florida, with many years in Webdesign Marketing and Social Media. Our main goal is customer satisfaction. We have great plan to improve your business. Feel free to contact us anytime.

Contact Us:

Phone: 715-699-2124
E-mail: Latif.ajre.8@gmail.com

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Current Address

1) Previous Address

2) Previous Address

3) Previous Address

EMPLOYMENT HISTORY

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